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Legal confusion cuts French cornea transplants

Eye surgeons in France have been forced to cut back drastically on the
number of cornea transplants they perform, following a French couple’s complaint
that their dead son’s eyes were removed without their permission.

The complaint spurred the government to tighten up regulations over
the ethics of cornea donation, an area which is a legal minefield in France.
Patrick Sabatier, a doctor at the Paris-based eye bank, Banque Francaise
des Yeux, said last week that the government action cut off supplies of
donated tissue to France’s principal cornea transplant centres, including
Paris, Lyons – which shut down on 1 September – Marseilles, Toulouse and
Nantes. Sabatier says he received six corneas in September: in previous
years he would have received between 50 and 60.

In the wake of the case, Pierre Kormann, administrative director of
France-Transplant, the organisation which coordinates transplants, says
that the number of refusals for donation of all organs has increased by
30 per cent. Surgeons say there has been an even bigger rise in refusals
for cornea donations.

The legal situation governing corneas is confused. A law passed in 1949
stated that a person’s eyes could only be used for transplant if that person
had expressed that desire in writing. A further law in 1976 stated that
any organ could be removed for transplant if the dead person had never expressed
a wish to the contrary. A later regulation gave close relatives the power
to witness that the dead person had objected to their organs being removed.

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After 1976 many doctors ignored the older law, and Sabatier and Kormann
say that doctors did not always inform next of kin before the corneas were
removed from a corpse.

The present turmoil began in May when the couple lodged a complaint
in a court in the northern city of Amiens after learning that doctors had
removed their dead son’s eyes for use in transplant surgery.

The case was highlighted in the press, and in June health minister Bernard
Kouchner responded by telling surgeons that before removing corneas they
must consult close relatives to find out if the dead person had ever expressed
a wish not to donate them.

Sabatier says that last week Kouchner backtracked, telling surgeons
they must try to reach close family members for six hours, after which time
consent to organ donation is presumed. Kouchner’s office confirmed this
policy, although it has not been publicly announced.

Sabatier says that this summer’s confusion created an impossible situation
because corneas for transplant must normally be removed within six hours
of death. He says hospital administrators are refusing to ask relatives
about cornea donation because they feel it is up to doctors. However, doctors
say they are not always available when the relatives are found. Bernard
Delbosque, an eye surgeon in Besancon, says doctors are confused about how
many relatives need to be contacted. He argues that donation is solely an
issue for the individual.

Kouchner says the new regulations will last only until the adoption
of a wide-ranging bioethics bill, expected to be debated by National Assembly
this autumn. The proposed law calls for the setting up of a central computer
system for people to register their objection to the use of their organs
for transplant. If their wishes are not recorded, the draft would require
doctors to consult the next of kin.